Noninvasive detection of risk for emotion-provoked myocardial ischemia.
OBJECTIVE
To test an easily administered, noninvasive technology to identify vulnerability to mental stress ischemia.


BACKGROUND
Myocardial ischemia provoked by emotional stress (MSI) in patients with stable coronary artery disease (CAD) predicts major adverse cardiac events. A clinically useful tool to risk stratify patients on this factor is not available.


METHODS
Patients with documented CAD (n = 68) underwent single photon emission CT myocardial perfusion imaging concurrent with pulse wave amplitude assessment by peripheral arterial tonometry (PAT) during a mental stress protocol of sequential rest and anger stress periods. Heart rate and blood pressure were assessed, and blood was drawn for catecholamine assay, during rest and stress. MSI was defined by the presence of a new perfusion defect during anger stress (n = 26) and the ratio of stress to rest PAT response was calculated.


RESULTS
Patients with MSI had a significantly lower PAT ratio than those without MSI (0.76 +/- 0.04 versus 0.91 +/- 0.05, p = .03). An ROC curve for optimum sensitivity/specificity of PAT ratio as an index of MSI produced a sensitivity of 0.62 and a specificity of 0.63. Among patients taking angiotensin converting enzyme (ACE) inhibitors, the sensitivity and specificity of the test increased to 0.86 and 0.73, respectively; 90% of patients without MSI were correctly identified.


CONCLUSIONS
PAT in concert with ACE inhibition may provide a useful approach to assess risk for MSI. Future studies should help determine how best to utilize this approach for risk assessment in the clinical setting.
Burg
Matthew M
MM
Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06520-8017, USA. mb2358@columbia.edu
Graeber
Brendon
B
Vashist
Aseem
A
Collins
Dorothea
D
Earley
Christine
C
Liu
Joyce
J
Lampert
Rachel
R
Soufer
Robert
R
D000368:Aged; D000786:Anger / Q000502:physiology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D004837:Epinephrine / Q000097:blood; D005260:Female; D006339:Heart Rate; D006801:Humans; D019018:Imagery, Psychotherapy; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000523:psychology; D009638:Norepinephrine / Q000097:blood; D010991:Plethysmography / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D012306:Risk; D012680:Sensitivity and Specificity; D013315:Stress, Psychological / Q000097:blood / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D015899:Tomography, Emission-Computed, Single-Photon; D014655:Vascular Resistance / Q000187:drug effects
D000806:Angiotensin-Converting Enzyme Inhibitors; D009638:Norepinephrine; D004837:Epinephrine